- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.41 / $7,340.00 / $13,413.92
| Facility | | $1,250.41 | $7,340.00 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.18 / $426.25 / $2,401.67
| Professional | | $323.18 | $426.25 | $2,401.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.15 / $631.15 / $1,428.01
| Professional | | $631.15 | $631.15 | $1,428.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.38 / $573.98 / $3,434.39
| Facility | | $474.38 | $573.98 | $3,434.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.28 / $1,273.17 / $2,296.00
| Professional | | $941.28 | $1,273.17 | $2,296.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.25 / $1,783.35 / $2,400.96
| Professional | | $1,396.25 | $1,783.35 | $2,400.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $573.98 / $652.82 / $3,434.39
| Facility | | $573.98 | $652.82 | $3,434.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.00 / $1,834.80 / $2,561.48
| Professional | | $498.00 | $1,834.80 | $2,561.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $507.78 / $1,144.18 / $3,459.37
| Professional | | $507.78 | $1,144.18 | $3,459.37 |